Berks County Medical Society Medical Record Fall 2017 - 12

transgender health care & Public policy
continued from page 11
you really need? Your insurance providers are skeptical as well. Of
course, they believe that you think you're diabetic. However, it's very
possible that you are misinterpreting symptoms. Everyone at your
age is worried about diabetes and there has been so much about
it in the news lately. It's likely that you're just imagining it. They
cannot, in good conscience, pay for your insulin, when you might
later decide that you're not diabetic anymore. This is a metaphor,
and a flawed one. Diabetes is a disease whereas being transgender is
just an inherent aspect of someone's life and body. However, for an
estimated one point four million Americans (New York Times), this
is not a metaphor, but a daily struggle.
Not all the news is bad. In recent years substantial progress
has been made towards the protection
of transgender individuals' right to
health care. The Affordable Care Act sets
several standards to protect the rights
of transgender Americans. Under the
Affordable Care Act, insurance companies
that receive federal funding or have one or
more plans on a federal or state Marketplace
are not permitted to discriminate against
someone based on their gender identity.
This means that they cannot legally refuse
or cancel someone's coverage or increase
their rates due to their gender identity. They
also cannot deny coverage for care typically
associated with one gender. For example,
they cannot deny a transwoman a prostate
exam simply because her file lists her as
female. Similarly, with pelvic exams for
transmen (NCTE). However, despite these
measures being in place, The United States
Transgender Survey (USTS) still found
that fifty-five percent of participants who had sought coverage for
transition related surgery in the previous year had been denied and
twenty-five percent had been denied coverage for hormones.
The Affordable Care Act also makes it illegal for any health
program, provider, or organization that gets any federal funding,
including accepting Medicare or Medicaid payments for any
patients, or is administered by a federal agency, to discriminate
against someone because they are transgender (NCTE).
According to federal law, all of the following are considered to be
discrimination:
* refusing to admit or treat someone
* forcing someone to undergo intrusive and unnecessary
examinations
* refusing to provide someone with services that are readily
provided to other patients
* refusing to treat someone according to their gender identity
* not providing them with access to restrooms consistent with
their gender identity
* harassing someone or refusing to respond to harassment by staff
or other patients
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* refusing to provide counseling, medical advocacy or referrals,
or other support services
* isolating someone or depriving them of human contact, or
limiting their participation in social or recreational activities
offered to others
* requiring someone to participate in "conversion therapy" for
the purpose of changing their gender identity
* harassing, coercing, intimidating, or interfering with someone's
ability to exercise their healthcare rights.
The State of Pennsylvania has also made a great step forward
in protecting the health care rights of transgender individuals.
In 2016, the state Medicaid program was reformed to cover
all medically necessary gender transition services (NCTE).
Unfortunately, there are only three surgeons in the state of
Pennsylvania who offer gender confirmation
surgeries and only one of them, Dr. Kathy
Rumer, accepts Medicaid (Dr. Levine). This
reform goes beyond even the protections
of the ACA, which does not require any
insurance companies to cover transitional
care.
Despite the advances that have
been made on the federal and state level
to protect the rights of transgender
individuals, it can still be very difficult for
them to access the care that they need when
dealing with insurance companies. It is not
an uncommon occurrence for insurance
companies to fight people on their status
as a transgender person, sometimes citing
the presence of mental illnesses as grounds
for disbelieving their claims (Dr. Good).
Claims for gender specific care, such as
prostate exams, mammograms, and pap
smears, are often immediately denied if
made by a person not matching the gender usually associated with
these services. So if they see someone they have listed as a man
asking them to pay for a pap smear they will say no because they
assume that he does not have a vagina and that it is therefore not
a necessary procedure. The patient can call to contest the decision
and often their procedure will end up getting paid for, but it is
a taxing and often embarrassing ordeal that transgender people
encounter quite frequently. A significant danger that several of the
physicians that I spoke to were very concerned about is that when
insurance companies make it impossible for a transgender person to
access their Hormone Replacement Therapy (HRT), often they will
resort to self-medication. People will sometimes buy hormones over
the internet from Canada, Mexico, or China and will figure out
their dosage based on the experiences of their friends, or just pure
guessing. This is very dangerous because estrogen HRT increases
risks of breast cancer and heart disease. Testosterone HRT increases
risks of blood clots, and they both increase a person's risk of stroke.
Anyone on HRT needs to be closely monitored by a physician and
to have their dosage professionally prescribed. Self-prescribing can
cause permanent health damage and nobody should be put in a
position where they feel it is their only option (Dr. Hernandez and
Dr. Lowery).


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Berks County Medical Society Medical Record Fall 2017

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2017

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